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| {{DiseaseDisorder infobox | | | '''For patient information, click [[{{PAGENAME}} (patient information)|here]]''' |
| Name = Laryngeal papillomatosis |
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| ICD10 = D14.1 |
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| ICD9 = {{ICD9|212.1}} |
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| {{Laryngeal papillomatosis}} | | {{Laryngeal papillomatosis}} |
| {{CMG}} | | {{CMG}} |
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| {{SK}} Recurrent respiratory papillomatosis; glottal papillomatosis | | {{SK}} Recurrent respiratory papillomatosis; RRP; glottal papillomatosis |
| ==Overview==
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| '''Laryngeal papillomatosis''', also known as recurrent respiratory papillomatosis, is a [[Rare disease|rare medical condition]] (2 per 100,000 adults and 4.5 per 100,000 children)<ref name="NIDCD">">{{cite web |title=National Institute of Deafness and other Communication Disorders|location= http://www.nidcd.nih.gov/health/voice/laryngeal.asp|accessdate=2009-09-19}}</ref>{{rp|411}}, caused by an [[Human papillomavirus|HPV]] infection of the throat. It causes assorted [[tumor]]s, [[papilloma]]s, to develop over a period of time. Without treatment it is potentially fatal as uncontrolled growths could obstruct the [[airway]]. Laryngeal papillomatosis is caused by HPV types 6 and 11, in which benign tumors form on the larynx or other areas of the respiratory tract. These tumors can recur frequently, may require repetitive surgery, and may interfere with breathing. The disease can be treated with surgery and antivirals.
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| ==Transmission==
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| In general, doctors are not sure what causes some people to contract laryngeal papillomatosis while others who have been exposed to HPV types 6 and 11 do not contract the disease. Since the disease is most commonly found in children the disease may be caused by an infant contracting HPV from the mother during vaginal child birth <ref name="Voice Problems">">{{cite web |title=VoiceProblems.org |location= http://www.voiceproblem.org/disorders/rrp/symptoms.asp|accessdate=2009-09-19}}</ref>{{rp|411}}. There is no evidence that it is transmitted through oral sex, and it is not considered a [[sexually transmitted disease]].<ref name="McClay">">{{cite web |author=McClay MD,John E (10/29/08).|title=Recurrent Respiratory Papillomatosis|location= http://www.voiceproblem.org/disorders/rrp/symptoms.asp|accessdate=2009-09-22}}</ref>
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| ==Symptoms== | | ==[[Laryngeal papillomatosis overview|Overview]]== |
| ===Adults===
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| In adults the symptoms Laryngeal papillomatosis are hoarseness, or a strained or breathy voice. Size and placement of the tumors dictate the change in the person's voice. Breathing difficulties may occur but more commonly are found in children.<ref name="Voice Problems" />
| | ==[[Laryngeal papillomatosis pathophysiology|Pathophysiology]]== |
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| ===Children=== | | ==[[Laryngeal papillomatosis causes|Causes]]== |
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| In babies and small children the symptoms include a weak cry, trouble swallowing, noisy breathing, and chronic cough. Noisy breathing may be a [[stridor]], which can sound like a whistle or a snore, and is a sign that the laryngeal or tracheal parts of the airway are narrowing.<ref name="Voice Problems" />
| | ==[[Laryngeal papillomatosis differential diagnosis|Differentiating Laryngeal papillomatosis from other Diseases]]== |
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| | ==[[Laryngeal papillomatosis epidemiology and demographics|Epidemiology and Demographics]]== |
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| | ==[[Laryngeal papillomatosis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ==Diagnosis== | | ==Diagnosis== |
| A doctor may diagnose laryngeal papillomatosis by placing a mirror into a patient's mouth to reflect light onto the vocal cords and examining the larynx. More often, a doctor or a trained speech-language pathologist diagnoses laryngeal papillomatosis by an indirect laryngoscopy in the office. This procedure involves the placement of a flexible, fiber optic camera through the patient's nose to view the vocal folds in the throat or the use of a straight, rigid camera placed through the mouth to view the vocal folds.<ref name="RRPF">">{{cite web |title=Recurrent Respiraory Papillomatosis Foundation|location= http://www.nidcd.nih.gov/health/voice/laryngeal.asp|accessdate=2009-09-26}}</ref>
| | [[Laryngeal papillomatosis history and symptoms|History and Symptoms]] | [[Laryngeal papillomatosis physical examination|Physical Examination]] | [[Laryngeal papillomatosis chest x ray|Chest X Ray]] | [[Laryngeal papillomatosis CT|CT]] | [[Laryngeal papillomatosis other diagnostic studies|Other Diagnostic Studies]] |
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| The most accurate way to diagnose laryngeal papillomatosis is for a [[biopsy]] to be conducted and for the lesion to be tested for HPV. This procedure takes place in an operating room with the patient under general anesthesia. This is sometimes the best option for small children. This disease is most often misdiagnosed as [[asthma]], [[croup]], or [[chronic bronchitis]].<ref name="McClay" /> The consequences may be serious, as papillomas are at least partially obstructing the airway to cause these symptoms and should be removed immediately.<ref name="RRPF" />
| | ==Treatment== |
| | [[Laryngeal papillomatosis medical therapy|Medical Therapy]] | [[Laryngeal papillomatosis surgery|Surgery]] | [[Laryngeal papillomatosis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Laryngeal papillomatosis future or investigational therapies|Future or Investigational Therapies]] |
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| == Treatment == | | ==Case Studies== |
| | | [[Laryngeal papillomatosis case study one|Case #1]] |
| Traditional [[surgery]] and [[carbon dioxide laser]] surgery, a "no touch" removal of affected tissue, are forms of treatment for laryngeal papillomatosis. Carbon dioxide laser removal is the most common removal method.<ref name="McClay" /> The carbon dioxide laser must be used precisely to prevent scarring, [[fibrosis]], and [[laryngeal web malformation]]. In children, carbon dioxide laser is effective for removing papillomas on the larynx.
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| [[Photodynamic therapy]] controls [[tumor]]s by using targeted dyes and bright light to illuminate tumors.<ref name="NIDCD" /> In this procedure, a doctor injects a light sensitive dye that is only absorbed by the tumors. Then the doctor activates the dye using a bright light, and the tumors are eliminated. This procedure has also been able to decrease the number of tumors that reoccur.<ref name="NIDCD" />
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| Another method is [[tracheotomy]], which reroutes air around the affected area. An incision is made in the front of the patient's neck, and a [[Tracheal tube|breathing tube]] is inserted through a hole (stoma) into the windpipe. The patient is then able to breathe through the tube. Although this is usually temporary, some patients must use the tube indefinitely.<ref name="NIDCD" /> This method should be avoided if at all possible, since insertion of a breathing tube may cause the tumors to form as far down as the lungs.<ref name="McClay" />
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| Many [[Antiviral drug]]s like Cidofovir have been used to treat laryngeal papillomatosis, but none completely stops the tumors from growing. Most antivirals are injected to control the frequency of tumor growth. The efficacy of the same is debated and subject to research. Some side effects of antivirals include dizziness, headaches, and body aches.
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| Regardless of the treatment used, the tumors will reoccur. In severe cases, tumors may occur once or twice a month. In less severe cases, tumors may occur once or twice a year.
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| | ==External Links== |
| | *[http://www.nidcd.nih.gov/health/voice/pages/laryngeal.aspx National Institute on Deafness and Other Communication Disorders information on Laryngeal Papillomatosis] |
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